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Well I’m down to the wire with two schools still in the running and one big decision to make. Where am I going to medical school next year?

The truth is I’ve decided to take the easy way out and let the money decide. Before too long I will know what my financial aid packages will look like and how much debt I can expect to be in when I graduate (read, a whole, stinking lot) and whichever number is slightly less terror-inducing will be my school of choice.

For students with slightly more discerning tastes, however, there is Second Look.

source: PSD Detail

Second Look is a chance for prospective med students to return to whichever schools have accepted them and have a, you guessed it, second look around. It’s a more casual setting than the interview and the pressure to impress is mostly gone. Now it’s the school’s turn to make a pitch (not that they weren’t doing that during the interview, but the utter terror of the day can make it hard to pay attention.)

Really what Second Look ended up being was two days of meeting many many new people and not remembering a single name.

The first evening was a reception. We entered the front room of the medical education building to find it crammed with acceptees and current students. Everyone was already sectioned off into little groups surrounding a center table with snacks and water. It was hot in the room and there was little room to maneuver. If I hadn’t had a fellow postbac buddy I probably would have turned right around and left. (Small talk is not my forte.)

Eventually we migrated to larger room and sat at large round tables that might someday be our classroom. At one point the medical school acapella group (no, I didn’t know medical schools had acapella groups either) came out and sang a few songs. There was no real end the evening; we just chatted with the folks at our table until, bit by bit, the people in the room drifted off in search of a real dinner.

The second day was a bit more organized. For one thing we had name tags this time around, which made it a lot easier to keep track of who I had already met. They also had their pitch ready to go; we sat through two panels and a classroom simulation about handling a disaster situation.

In the midst of the second panel, one of the fourth year girls described all of the amazing experiences she’d had during her rotations and I had a moment where I felt almost disembodied from my experience. This has happened to me a number of times during the past two years when it really hits me all of a sudden that I am doing this…I am going to medical school. How utterly strange. How crazy I would have thought anyone who might have claimed that this would be my future. Whether I attended the school in question, or my other possible choice, I was really, truly going to be a doctor someday.

So in some sense Second Look didn’t quite achieve its purpose. I have no clearer idea of where I want to be for the next four years, despite loving everything I heard about the school. But after nine months of feeling like I’m stuck in between steps, I’m starting to feel like maybe the race is on again. I can’t wait until August.

I never intended for my work at Planned Parenthood to become so central to this blog, but in light of a lot of recent controversy I wanted to add some facts to the discussion.

You see, I was confused when all of this talk began about the government mandating a transvaginal ultrasound prior to an abortion. I was confused because for the past year and a half I had been checking the box marked “Ultrasound for pregnancy dating” on the list of procedures my counseling patients had gone through. I had watched patients waiting to empty their bladders before having the ultrasound (because that is necessary for a clear image.) I even had one patient shudderingly tell me how she had invited her husband in, expecting the more tradition ultrasound, only to have to tell him to close his eyes when the wand was inserted.

The clinic has been doing two transvaginal ultrasounds as a matter of course; once prior to the abortion and once at the two week follow-up to make sure the contents of the uterus had been removed successfully. They have not been doing this out of malice or a desire to sway their patients toward keeping the pregnancy. They were doing it because the doctors who worked at the clinic felt that it was medically necessary.

Why? Two reasons. First to make sure that the patient is actually pregnant. If she is not far enough along that the image can be seen on the ultrasound, the patient might be giving a false positive pregnancy test. Performing an abortion on a woman who is not actually pregnant would be the textbook definition of medically unnecessary.

The doctor also has to make sure the pregnancy isn’t too far along so as to violate the parameters on when an abortion is legal. It also lets the doctor know if the pregnancy is nearing that limit. Women going on 12 or 13 weeks are given an extra medication prior the surgery to make things go more easily. Women opting for the medical abortion (the abortion pill) have an earlier cutoff point. Dating the pregnancy gives important information to the physician.

A transvaginal ultrasound is not the only means of dating a pregnancy. A manual exam can give an accurate timeline as well. This is also an invasive procedure, but doesn’t require use of the ultrasound wand or result in an image of the fetus.

This is where it gets tricky. The question of “medically necessary” varies from physician to physician. The doctors I work with think that it is necessary. Another physician may find the manual exam adequate. It is a medical decision, and as much as we would like to believe those are universal, they are not always clear cut.

But they are medical decisions, not legal ones. That is why we should be angry about the attempt to pass these laws. No politician, particularly one who believes abortion to be immoral, has taken the time to research and understand the nuances of a decision like that. I can’t even decide, and I have watched the abortion procedure and explained it to patients in great detail on a weekly basis. There is no comparable law on the books that dictates a medical decision in such a way.

The issue here is physician autonomy as it relates to women’s rights. It’s an important issue, I won’t deny it.

On the other hand, it frustrates me to no end to have this procedure compared to rape. This is a legitimate medical process that provides valuable information necessary to a successful medical procedure. The doctors who choose to perform transvaginal ultrasounds are not raping their patients and to imply that for the sake of demonizing the opposing side is damaging and hyperbolic. It’s not a lot of fun, but it is far from the emotionally scarring, physically traumatizing experience of being forced to engage in sexual intercourse. A woman undergoing a surgical abortion will be penetrated whether or not she has a transvaginal ultrasound. That is how a surgical abortion works. That is her choice. Remember? That’s what we’re fighting to hang onto here.

The other choice is that of the physician. He or she deserves to have the power over that decision, not a congressman with a soundbite to sell.

I hate it when Planned Parenthood is called an “abortion factory,” or when the wonderful people who work there are accused of pressuring women into the procedure. I hate it because it isn’t true and it isn’t fair. I don’t want to play that game. The fact is that the attempted government mandate would dictate the actions of physicians in a way that no other medical procedure would tolerate. The fact is that the individuals behind the mandate are not qualified to override doctors’ medical opinions.

But rape is rape. A transvaginal ultrasound is not.

Illustrations in textbooks can easily go unnoticed, but that doesn’t mean a great deal of thought and detail hadn’t gone into their creation. Occasionally a detail will stand out in a way that makes you remember that there was an actual artist on the other end of image’s existence. I remember in my biology textbook the artist would use this blurring effect to indicate motion, implying that the enzymes involved in DNA replication were just whizzing along like streetcars on a rail.

This video shows the making of a medical illustration. I found it interesting the type of prep work that goes into creating the image. It seems obvious, but I never really thought about how the illustrator would become familiar with the structures, particularly in a more advanced text like the one used as example (neurosurgery.) Certainly the artist doesn’t need an MD, but they should have enough of an understanding of the process to highlight the important pieces of the process.

Which makes me wonder if there aren’t doctor-illustrators out there. There are enough doctor writers, and the textbooks themselves are written by experts. It seems like it would be helpful to have an artist with a medical background, someone who would know from experience which details to include and which are distracting.